Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
Yonsei Med J. 2023 Feb;64(2):104-110. doi: 10.3349/ymj.2022.0437.
Pulmonary thromboembolism is a potentially life-threatening condition in patients with heart disease; however, limited studies discussing long-term outcomes exist. This study aimed to investigate the long-term outcomes of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH), focusing on the improvement of functional class and right ventricular (RV) pressure.
Clinical data of patients with CTEPH were obtained from Yonsei Hospital between May 2012 and December 2021, and reviewed retrospectively. Twenty-six patients underwent endoscope-guided PEA during the study period, and the mean follow-up duration was 24.8±23.4 months.
After PEA, most patients (88.5%) were weaned from inotropes without extracorporeal membrane oxygenation support during the first few days. Two patients (7.6%) had cerebrovascular accidents without neurological deficits. On echocardiography, the RV systolic pressure and tricuspid regurgitation grades significantly improved (<0.001). Furthermore, the mean left ventricle end-diastolic diameter was significant increased (=0.003), and the left ventricular end-systolic diameter increased (<0.001). The median intensive care unit stay was 3.0±9.4 days, and median hospital stay 16.0±26.5 days. The 5-year survival rate was 95.5%, and the 5-year freedom rate of cardiac death was 100%. There was a marked improvement in New York Heart Association (NYHA) status (<0.001). Cox regression suggested that the main pulmonary artery (MPA) involvement is a significant predictor of non-improvement in functional class post-PEA.
Mortality rates are low and patients experience a marked improvement in NYHA class and health status after PEA. Moreover, MPA involvement may affect functional outcomes.
在心脏病患者中，肺血栓栓塞是一种潜在的危及生命的疾病；然而，目前关于其长期预后的研究有限。本研究旨在探讨慢性血栓栓塞性肺动脉高压（CTEPH）患者行肺动脉内膜剥脱术（PEA）的长期预后，重点关注心功能分级和右心室（RV）压力的改善。
从 2012 年 5 月至 2021 年 12 月，回顾性分析在延世医院接受 CTEPH 治疗的患者的临床资料。在此期间，有 26 例患者接受了内镜引导下的 PEA，平均随访时间为 24.8±23.4 个月。
PEA 后，大多数患者（88.5%）在最初几天内无需使用正性肌力药物和体外膜肺氧合支持即可脱机。2 例（7.6%）发生无神经功能缺损的脑血管意外。经超声心动图检查，RV 收缩压和三尖瓣反流分级显著改善（<0.001）。此外，左心室舒张末期直径均值显著增加（=0.003），左心室收缩末期直径增加（<0.001）。重症监护病房住院时间中位数为 3.0±9.4 天，住院时间中位数为 16.0±26.5 天。5 年生存率为 95.5%，5 年心脏死亡无事件生存率为 100%。纽约心脏协会（NYHA）心功能分级显著改善（<0.001）。Cox 回归分析表明，主肺动脉（MPA）受累是 PEA 后心功能分级无改善的显著预测因素。
PEA 后死亡率较低，NYHA 心功能分级和健康状况显著改善。此外，MPA 受累可能影响功能结局。
